Cardiothoracic Surgery

Question 1

An infant is seen in your clinic due to respiratory difficulty. His mother says he will make a “crowing” sound with breathing and extend himself to breathe better. Upon investigating further, she admits he doesn’t eat too much. The diagnosis and treatment are?

Answer 1

Vascular rings

Surgery to divide the smaller of the two aortic arches

Question 2

A 1-year old with frequent colds is brought in by his mother. On exam he has a systolic murmur and fixed split S2. The patient likely has? Treatment?

Answer 2

ASD

Catherization

Question 3

A 2 month infant with a pansystolic murmur, pulmonary hypertension. and failure to thrive will have this on ECHO?

Answer 3

VSD

Question 4

List the common findings on a child with tetralogy of fallot.

Answer 4

• episodes of cyanosis relieved by squatting
• small size with distal clubbing
• systolic ejection murmur
• RVH and small heart

Question 5

A systolic murmur and exertional syncope is characteristic of?

Answer 5

Aortic stenosis

Question 6

Valve replacement for aortic stenosis is needed if?

Answer 6

• gradient >50 mm Hg

- CHF

Question 7

• wide pulse pressures

- diastolic murmur worsened by full expiration

Answer 7

Aortic insufficiency

Question 8

Prosthetic valve’s will indicate?

Answer 8

The need for antibiotic prophylaxis

Question 9

What are the characteristics of a patient with mitral stenosis?

Answer 9

• dyspnea in exertion
• cough and hemoptysis
• rumbling diastolic murmur

Question 10

Mitral regurgitation is most likely to be heard?

Answer 10

Holosystolic that radiates to axilla and back

Question 11

What is the indication for revascularization of coronary vessels?

Answer 11

> 70% stenosis with good distal flow

Question 12

How would you treat single vessel coronary disease versus multi-vessel coronary disease?

Answer 12

Single vessel: angioplasty and stent

Multi-vessel: coronary bypass

Question 13

What does the pulmonary wedge pressure tell you in a patient with low cardiac output?

Answer 13

Low (<3): IV fluids needed

High (>20): ventricular failure

Question 14

What are exam characteristics of constrictive pericarditis?

Answer 14

• dyspnea on exertion
• hepatomegaly
• ascites
• square root sign (filling pressure)
• Cath showing equalization of pressures

Question 15

What is the best initial workup for lung cancer?

Answer 15

• comparing chest xray’s

- CT and sputum cytology

Question 16

How is lung cancer diagnosed?

Answer 16

Bronchoscopy with biopsy for central lesions and percutaneous biopsy for peripheral lesions.

Question 17

Small cell lung cancer is treated with?

Answer 17

Chemo and radiation

Question 18

What residual lung function is required after surgery for a lung cancer to be considered operable?

Answer 18

FEV1 of 800 mL

Question 19

Patients with massive hemoptysis will lose how much blood? Death in this case is generally due to?

Answer 19

> 600 cc

Asphyxiation

Question 20

How do you differentiate between a lung module and lung mass?

Answer 20

A nodule <3 cm, a mass is >/= 3 cm

Question 21

The majority of lung cancers are?

Answer 21

Non-small cell

Question 22

Evaluation of the cause of a pleural effusion is done via?

Answer 22

Light’s Criteria

Question 23

Diagnosis of a chylothorax is made by?

Answer 23

Thoracentesis showing TG’s >110 mg/dL or chylomicron presence

Question 24

Patients with a tension pneumothorax should have this done before a chest tube is placed?

Answer 24

Needle decompression